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Kidney Week

Abstract: FR-PO874

Reduced Early Acute Rejection with Depleting Induction and Steroid Minimization Maintenance in Pediatric Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Yanik, Megan V., University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Weaver, Lucinda, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Seifert, Michael E., University of Alabama at Birmingham, Birmingham, Alabama, United States
Background

Prolonged steroid exposure in pediatric kidney transplant recipients (PKTRs) can result in adverse effects. Recent studies indicate steroid minimization (SM) is effective compared to steroid based (SB) regimens, but outcomes data in PKTRs are limited. Subclinical rejection is prevalent in PKTRs, and is associated with poor outcomes.

Methods

We hypothesized that SM with depleting induction would decrease risk of acute rejection (AR) during the first post-transplant year in PKTRs compared to a SB regimen with non-depleting induction. A single-center, retrospective cohort study was performed on PKTRs from 8/2011 to 8/2017. The primary exposure was the immunosuppression regimen. Biopsies were performed for surveillance at 3- and 6-months post-transplant, and as indicated for allograft dysfunction. The primary outcome was AR by 1 year, including borderline, cellular, and antibody mediated. Secondary outcomes included allograft function, calcineurin inhibitor nephrotoxicity (CNIT), viral infections, and neutropenia.

Results

The cohort included 63 PKTRs; 21 and 42 patients on the SM and SB regimens. The median age at transplant was 12.9 years. The cohort included 37% black and 71% deceased donor PKTRs. Overall, 32% of PKTRs had AR by 1 year post-transplant, with 80% of those detected on surveillance biopsy. By Kaplan-Meier analysis, PKTRs on SM had significantly less AR than those on the SB regimen (Figure 1, log rank p = 0.02). There was no significant difference in mean eGFR at 1 year in the SM vs SB groups. There were also no differences in the rate of CNIT, BK nephropathy, CMV viremia, or neutropenia. PKTRs in the SM group had a lower incidence of EBV viremia (33% vs 69%, p = 0.01).

Conclusion

The incidence of AR in the first year post-transplant was significantly reduced in PKTRs undergoing a SM regimen. Further study is needed to determine the effect of SM on long term outcomes in PKTRs.

Figure 1